Climate change will lead to more extreme weather events such as heatwaves and hurricanes, which were found to be associated with increased mortality and morbidity. However, significant gaps remain in our understanding of the impacts from extreme weather event like hurricanes, including the paucity of research on its immediate and long-term health effects, other health outcomes despite mental health, individual and community vulnerabilities, and modified factors. Furthermore, little is known about the health impacts of response and recovery strategies. The proposed study will fill these gaps by evaluating the short- and long- term effects on multiple health outcomes and risk factors in the aftermath of Hurricane Sandy in New York State (NYS). This project will address all four priority areas described under Priority Recovery Research Area B of the RFA-TP13-001 by assessing mortality and multiple relevant morbidity including mental health, injury, respiratory, cardiovascular diseases, CO poisoning, infectious diseases, water-/food-borne diseases, and dialysis (Aim 1). We will further evaluate whether low socio-economic status (SES), environmental factors, community characteristics, and social vulnerability modified the Sandy-health association (Aim 2). Moreover, our study will assess the health effects of different evacuation or displacement strategies and impacts of health care access disruption by Hurricane Sandy (Aim 3). Care pattern change in dialysis patients and consequence of patient transfer will also be evaluated. Finally, we will determine the modifiable risk factors, effective home cleaning strategy and surveillance to reduce health burden. By using multiple NYS datasets, including hospital admission, emergency department visit, clinic visit and prescription billing data, and community surveys, we will recruit all potential mental health and other cases. The two surveys planned among school staff and residents with oil spill homes will collect detailed information on mental health, activity patterns during Sandy, and home cleaning. Each health outcome will be compared between the affected areas (categorized as evacuation zones in the 7 impacted counties) and the control areas (unaffected by Sandy in the same county and similar SES) using unconditional logistic regression analysis in a retrospective cohort study. Trend analysis will also be used to compare pre- and post-Sandy effects using ARIMA, a time-series analysis method. All outcomes will be compared within three time windows, pre-Sandy, 3 months and 1-year after Hurricane Sandy. The proposed study is important as it will not only characterize the impacts of multiple health outcomes after Hurricane Sandy and using different evacuation or recovery strategies, but also identify vulnerabilities and modifiable factors, which will directly contribute to emergency preparedness and responses. The strong state-county-community partnership, unique access to multiple large NYS datasets, and the experienced multidisciplinary research team will assure that the project is feasible and sustainable.